Provider Demographics
NPI:1053181248
Name:JLB THERAPY LLC
Entity type:Organization
Organization Name:JLB THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:LYNCH
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-575-3491
Mailing Address - Street 1:47 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1823
Mailing Address - Country:US
Mailing Address - Phone:860-575-3491
Mailing Address - Fax:
Practice Address - Street 1:762 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3047
Practice Address - Country:US
Practice Address - Phone:860-575-3491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health